Pediatric emergency medicine trisk 1128 1128
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FIGURE 58.2 A: Normal tympanic membrane (TM). B: TM full/mild bulging (antibiotic
treatment not indicated). C: TM with moderate bulging. D: TM with severe bulging.
Antibiotic treatment of AOM has been controversial due to the high
spontaneous resolution rate of AOM in many older studies. Using a more
stringent diagnostic threshold for AOM, recent studies have documented a
modest but statistically significant benefit of antibiotics for AOM. Antibiotic
treatment is recommended for any child with AOM and severe symptoms,
defined as moderate or severe otalgia, otalgia for greater than 48 hours or
temperature >39°C (102.2°F). For children between 6 and 24 months of age,
observation without antibiotics is an option if AOM is unilateral and symptoms
are not severe. Observation is an option for patients >24 months of age with
AOM without severe symptoms even if the AOM is bilateral. In all cases for
which observation is the chosen option, the clinician must arrange for follow-up
